Pharmacy Benefits Manager (PBM)
February 23, 2016
Dear Mr. PBM,
You win! I can’t fight you anymore. You are powerful; and, since January, you have been flexing your muscles and crushing all that dare to challenge you. I’m beaten and despondent.
You refuse to pay for lifesaving medications. You refuse to pay for medications patients have been on for years. You refuse to pay for anything branded and now you even refuse to pay for many generics.
You demand that an appropriately treated and well controlled patient previously suffering from depression give up his medication for one that you approve of. It doesn’t matter to you if my patient relapses into his prior depression. You don’t even try to justify your actions. You state that you aren’t denying my patient the right to his medication. You say he can pay for it himself. He can’t.
You’ve helped drive up the retail cost of his medication. His financial situation is one of the many factors contributing to his depression. You’ve left him no choice. You’ve left me no choice. He will change medication. He may suffer a relapse. You, on the other hand, will please your stockholders. You may even get a bonus at the end of the year.
You’re stifling innovation. You refuse to pay for a new, novel cholesterol lowering medication that can help those patients that cannot tolerate statins. I’ve tried to prescribe it to 5 patients and you have denied five requests. We have filed piles of paperwork trying to get this potentially lifesaving medication approved by your minions. You have rejected everyone. We have filed multiple appeals, all denied. My staff has invested hours of work costing me lots of money to no avail. You win. I won’t prescribe this medication again.
You’re increasing the cost of providing care in multiple ways. You don’t care. My patients will be referred to a preventative cardiologist at a major university hospital. Maybe he can succeed. Maybe he won’t. Maybe one of these five patients will have a heart attack while he/she waits for this medication. Maybe they will use this article to sue you. I hope so!
You are so sure of your power that you even refuse to pay for cyclobenzaprine, an old generic that retails for 50 cents a pill. You win! You are an insurance company that, while increasing your rates yearly, cuts expenditures regularly. Yes, you are powerful. The devil usually is; and, unfortunately, in the real world, the devil wins!
It’s no wonder so many docs commit suicide every year! Fighting the devil takes a toll on you.